Looking at what session co-moderators call the alpha to omega of thyroid cancer, a panel of renowned experts will review cases from a multi-disciplinary viewpoint during Sunday’s special session on thyroid cancer, beginning at 9:45 am in Ballroom D.
Co-moderators Peter Singer, MD, FACE, and Gregory W. Randolph, MD, FACS, FACE, will be joined by endocrine oncologist Steve Sherman, MD, and pathologist Yuri Nikiforov, MD, PhD, in a discussion of the wide range of thyroid cancers, from micropapillary cancers to aggressive invasive thyroid cancers.
“The panel is alpha to omega because thyroid cancer has an amazing range of aggressiveness from very minimally aggressive small lesions to some of the most devastating cancers that are known to humans including anaplastic thyroid cancer. It’s peculiar that one gland could be the origin of cancers of such divergent virulence,” said Dr. Randolph, who is the Clair and John Bertucci Endowed Chair in Thyroid Surgical Oncology at Harvard Medical School.
It’s that divergence that makes a multi-disciplinary approach so necessary. A patient with thyroid cancer requires a team working together to provide optimal care.
“It is important for endocrinologists to understand the perspectives from pathology, to understand the surgeon’s perspective, and vice versa to see how we put cases together to understand the pathophysiology and different treatment modalities,” said Dr. Singer, who is Professor of Clinical Medicine and Chief of Clinical Endocrinology in the Department of Medicine, Division of Endocrinology at the University of Southern California, Keck School of Medicine.
The panel will discuss micropapillary and other low-risk thyroid cancers that can possibly be managed without surgery or at least without a total thyroidectomy. The new American Thyroid Association guidelines will be included in the discussion.
Also, included will be discussion about non-invasive follicular thyroid neoplasm with papillary-like nuclear features, otherwise known as NIFTP, a reclassification of a tumor type previously referred to as a carcinoma. The reclassification was spearheaded by Dr. Nikiforov, Professor of Pathology, Vice-Chair, Department of Pathology, and Director, Division of Molecular & Genomic Pathology at the University of Pittsburgh.
“We are also going to have a difficult case of a patient who requires more surgeries. Dr. Randolph will discuss surgical approaches. The new ATA guidelines have made revisions on what should be the extent of initial surgery,” said Dr. Singer. “Dr. Randolph will also cover what you should do about surgery if you see disease down the line; should you operate on those patients, follow them, treat them with radioactive iodine and so forth.”
Dr. Randolph noted the panel discussion will be particularly useful in getting a multi-disciplinary update on the newest advances in recognizing and managing a variety of forms of low-risk thyroid tumors, NIFTP lesions and the more aggressive cancers that may require surgery, chemotherapy or radiation therapy.
“We’ll look at different types of surgical technology including neural monitoring to avoid bilateral vocal chord paralysis, new advances in tyrosine kinase treatment, which is not like the typical chemotherapy that you think about for lymphoma and leukemia, but for tyrosine kinase inhibitors which are pills that are given to patients,” said Dr. Randolph.
The panel will also consider a case of a patient with advanced thyroid cancer. When conventional therapy of surgery and in some cases radioactive iodine fails or the patient becomes resistant, chemotherapy has to be added to the treatment modality. Dr. Singer noted that Dr. Sherman is an expert in that area referred to as adjunctive therapy. Dr. Sherman is Associate Vice Provost, Clinical Research Chair in the Department of Endocrine Neoplasia and Hormonal Disorders and the Naguib Samaan Distinguished Professor in Endocrinology at the University of Texas MD Anderson Cancer Center.
“It’s important for the endocrinologist who is really the quarterback of treating patients with thyroid cancer, so they can get a good feel for current approaches of surgical, non-surgical and adjunctive therapy and management of thyroid cancer,” said Dr. Singer.